HCBS SME​/Lead Business Analyst

Summary ESI is seeking an experienced HCBS Subject Matter Expert (SME) / Lead Business Analyst to provide strategic, functional, and operational expertise in support of Home and Community-Based Services (HCBS) programs. This individual will serve as the primary liaison between business stakeholders, program leadership, policy teams, and technical development teams to ensure systems, processes, and solutions align with federal and state Medicaid HCBS regulations and program objectives.

The ideal candidate possesses deep knowledge of Medicaid waivers (1915(c), 1115, 1915(i), 1915(k)), CMS requirements, person-centered service planning, EVV, LTSS systems, and HCBS compliance frameworks.

• Serve as the primary SME for HCBS programs, policies, waiver services, and compliance requirements.
• Interpret and translate federal CMS guidance, Medicaid regulations, and state-specific HCBS policies into functional and technical requirements.
• Provide expert guidance on waiver design, service definitions, provider enrollment, claims, eligibility, and reimbursement models.
• Support compliance with CMS Final Rule and person-centered planning requirements.
• Lead requirements elicitation sessions with stakeholders including program staff, IT teams, vendors, providers, and state/federal partners.
• Develop and maintain:
• Business Requirements Documents (BRDs)
• Functional Requirements Documents (FRDs)
• User Stories and Acceptance Criteria
• Process flows and data mapping documentation
• Facilitate gap analyses between current and future state processes.
• Oversee traceability from requirements through implementation and testing.
• Lead design and implementation of LTSS/HCBS systems, including case management systems, provider management modules, EVV solutions, claims and billing systems, and eligibility and enrollment systems.
• Collaborate with technical teams to ensure accurate configuration aligned with HCBS policies.
• Support data conversion, system integration, and reporting requirements.
• Serve as trusted advisor to program leadership on HCBS transformation initiatives.
• Support audits, federal reporting, and quality assurance reviews.
• Provide training and knowledge transfer to staff and stakeholders.
• Participate in vendor oversight and RFP development for HCBS-related procurements.
• Lead User Acceptance Testing (UAT) efforts.
• Develop test plans and test cases aligned to HCBS business rules.
• Validate system outputs against regulatory and program requirements.

• Bachelor’s degree in Public Administration, Health Policy, Business, IT, or related field (Master’s preferred).
• Seven years of experience working with the implementation of a Case Management system of similar scope and size, and five years of experience working with HCBS programs in at least one state government in the United States.
• Demonstrated Experience with 1915(c) waiver programs and CMS HCBS Final Rule.
• Strong understanding of person-centered planning and EVV (Electronic Visit Verification).
• Medicaid eligibility and claims processes knowledge.
• Strong understanding of systems development lifecycle (SDLC).
• Experience leading cross-functional teams.
• Excellent written and verbal communication skills.

• Experience working with state Medicaid agencies.
• PMP, CBAP, or similar certification.
• Experience with MMIS or modular Medicaid systems.
• Knowledge of federal reporting requirements (e.g., CMS-372, CMS-64).
• Experience supporting federal compliance reviews or corrective action plans.
• Familiarity with Agile methodologies and tools (JIRA, Azure Dev Ops).